Gestational diabetes - paradigm lost?

Abstract

Despite a prodigious number of publications on the subject of gestational diabetes, great uncertainty persists about its significance and how it should be diagnosed. We suggest that the problem lies with concepts introduced over thirty years ago: first that gestational diabetes is a distinct disease requiring ‘diagnosis’ and second that this entity should include all degrees of glucose intolerance in pregnancy, with the presumption of equal risk across the range. We argue that fetal risks clearly differ according to the degree of maternal glycaemia, being greatest for those with previously undiagnosed diabetes and lowest for those with minimally raised blood glucose. In the latter, ‘gestational diabetes’ is primarily a risk factor for macrosomia and hypertension in pregnancy, but probably not the most important: maternal obesity and excessive gestational weight gain are of greater significance. From this perspective, gestational diabetes is a risk factor rather than a disease, and while there are good reasons to reduce the incidence of large babies and hypertension, it is more logical to look at all risk factors involved. The excessive ‘glucocentric’ focus and the quixotic pursuit of perfect diagnostic criteria in much recent research are hindering rather than helping our understanding

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ORCID for Richard Holt: orcid.org/0000-0001-8911-6744

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